Provider Demographics
NPI:1952350233
Name:ALTABBAA, AHMAD H (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:H
Last Name:ALTABBAA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3836
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38088-3836
Mailing Address - Country:US
Mailing Address - Phone:901-791-2764
Mailing Address - Fax:901-791-2783
Practice Address - Street 1:3950 NEW COVINGTON PIKE
Practice Address - Street 2:SUITE 290
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2595
Practice Address - Country:US
Practice Address - Phone:901-791-2764
Practice Address - Fax:901-791-2783
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27191207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN30992701Medicaid
TN30992701Medicaid
TN30992701Medicare PIN